Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Road, 3002 VIC, Melbourne, Australia.
Oesophago-Gastric and Bariatric Surgical Unit, Department of General Surgery, The Alfred Hospital, Melbourne, 3004, Australia.
Obes Surg. 2022 Jun;32(6):1822-1830. doi: 10.1007/s11695-022-06019-7. Epub 2022 Mar 30.
To evaluate the long-term outcomes of revisional malabsorptive bariatric surgery.
Malabsorptive bariatric procedures are increasingly performed in the revisional setting. We collated and analysed prospectively recorded data for all patients who underwent a revisional Biliopancreatic diversion + / - duodenal switch (BPD + / - DS) over a 17-year period.
We identified 102 patients who underwent a revisional BPD + / - DS. Median follow-up was 7 years (range 1-17). There were 21 (20.6%) patients permanently lost to follow-up at a median of 5 years postoperatively. Mean total weight loss since the revisional procedure of 22.7% (SD 13.4), 20.1% (SD 10.5) and 17.6% (SD 5.5) was recorded at 5, 10 and 15 years respectively. At the time of revisional surgery, 23 (22.5%) patients had diabetes and 16 (15.7%) had hypercholesterolaemia with remission of these occurring in 20 (87%) and 7 (44%) patients respectively. Nutritional deficiencies occurred in 82 (80.4%) patients, with 10 (9.8%) patients having severe deficiencies requiring periods of parenteral nutrition. Seven (6.9%) patients required limb lengthening or reversal procedures. There were 16 (15.7%) patients who experienced a complication within 30 days, including 3 (2.9%) anastomotic leaks. Surgery was required in 42 (41.2%) patients for late complications.
Revisional malabsorptive bariatric surgery induces significant long-term weight loss and comorbidity resolution. High rates of temporary and permanent attrition from follow-up are of major concern, given the high prevalence of nutritional deficiencies. These data question the long-term safety of malabsorptive bariatric procedures due to the inability to ensure compliance with nutritional supplementation and long-term follow-up requirements.
• Revisional bariatric surgery workload is increasing • Revisional malabsorptive surgery is efficacious for weight loss and comorbidity resolution • Revisional malabsorptive surgery is associated with high rates of nutritional deficiencies • Attrition from follow-up in this specific cohort of patients is of particular concern due to the risk of undiagnosed and untreated nutritional deficiencies.
评估可复发性吸收不良性减重手术的长期效果。
吸收不良性减重手术在可复发性减重手术中越来越常见。我们收集并分析了 17 年来所有接受可复发性胆胰分流术+/-十二指肠转位术（BPD+/-DS）的患者的前瞻性记录数据。
我们共纳入 102 例接受可复发性 BPD+/-DS 的患者。中位随访时间为 7 年（1-17 年）。21 例（20.6%）患者在术后 5 年时永久性失访。自可复发性手术以来，体重减轻的平均值为 22.7%（SD 13.4）、20.1%（SD 10.5）和 17.6%（SD 5.5），分别记录于术后 5、10 和 15 年。在进行可复发性手术时，23 例（22.5%）患者患有糖尿病，16 例（15.7%）患有高胆固醇血症，其中 20 例（87%）和 7 例（44%）患者的病情得到缓解。82 例（80.4%）患者出现营养缺乏，10 例（9.8%）患者出现严重缺乏，需要接受一段时间的肠外营养。7 例（6.9%）患者需要进行肢体延长或反转手术。16 例（15.7%）患者在 30 天内出现并发症，包括 3 例（2.9%）吻合口漏。42 例（41.2%）患者因迟发性并发症需要手术治疗。
可复发性吸收不良性减重手术可显著减轻体重并解决合并症。临时和永久性随访流失率较高，令人严重关切，考虑到营养缺乏症的高患病率。这些数据由于无法确保遵守营养补充和长期随访要求，对吸收不良性减重手术的长期安全性提出质疑。
可复发性减重手术工作量不断增加。
可复发性吸收不良性手术对减轻体重和解决合并症有效。
可复发性吸收不良性手术与高营养缺乏率相关。
由于存在未确诊和未治疗的营养缺乏症风险，因此该特定患者队列中失访的情况尤其令人担忧。
